Individual
LARRY K BROADWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
820 JORDAN ST, SUITE 201, SHREVEPORT, LA 71101-4518
(318) 221-0399
(318) 221-1940
Mailing address
820 JORDAN ST, SUITE 201, SHREVEPORT, LA 71101-4518
(318) 221-0399
(318) 221-1940
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
013598
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1303429
—
LA
Enumeration date
01/26/2007
Last updated
11/16/2007
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